Vasquez sees a difference between how he deals with patients and how other doctors do. He would like to see the organizations recognize that difference.

“As an emergency physician, I am more volume and less margin, but a neurosurgeon would fall into the high-margin, low-volume category,” he said. “If I’m going to spend any money to attract anybody, it’s going to be specialty care.”

And that’s the problem, he said.

“Everybody is competing for the same pool of providers,” he said.

While the first step of an ACO sounds great, with doctors getting bonuses for providing quality care at a lower cost, the second step may be daunting: When those quality and cost measures aren’t achieved, all doctors in the network share the risk.

“Getting us to take the downside risk would be difficult,” he said. “We are risk-averse.”